本文關(guān)鍵詞： 奧馬哈系統(tǒng) 呼吸系統(tǒng) 延續(xù)護(hù)理 自我管理能力 生存質(zhì)量 護(hù)理滿意度　出處：《南京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的構(gòu)建出適合我國(guó)國(guó)情的呼吸內(nèi)科出院患者醫(yī)院社區(qū)一體化延續(xù)護(hù)理模式。評(píng)價(jià)該模式的實(shí)施效果,驗(yàn)證該模式的實(shí)施能滿足呼吸內(nèi)科出院患者的專業(yè)化護(hù)理需求。研究方法本研究采用奧馬哈問(wèn)題分類系統(tǒng)作為理論框架,編制出"呼吸內(nèi)科出院患者護(hù)理需求評(píng)估表";同時(shí),對(duì)150例呼吸內(nèi)科出院患者的護(hù)理需求及出院時(shí)所存在的健康問(wèn)題進(jìn)行調(diào)查�；谇捌谡{(diào)查結(jié)果及國(guó)內(nèi)外文獻(xiàn),構(gòu)建呼吸內(nèi)科出院患者醫(yī)院社區(qū)一體化延續(xù)護(hù)理服務(wù)模式,主要包括3個(gè)部分:①三級(jí)醫(yī)院:建立呼吸內(nèi)科出院患者信息檔案,評(píng)估出院患者的護(hù)理需求及問(wèn)題,制定延續(xù)護(hù)理計(jì)劃,培訓(xùn)及指導(dǎo)社區(qū)護(hù)士;②三級(jí)醫(yī)院和社區(qū)衛(wèi)生服務(wù)中心的銜接:建立QQ交流平臺(tái),醫(yī)院護(hù)士將呼吸內(nèi)科患者的電子信息檔案及延續(xù)護(hù)理計(jì)劃轉(zhuǎn)介給社區(qū)衛(wèi)生服務(wù)中心,社區(qū)護(hù)士及時(shí)反饋進(jìn)展;③社區(qū)衛(wèi)生服務(wù)中心:社區(qū)護(hù)士及時(shí)接收呼吸內(nèi)科出院患者的電子信息檔案及延續(xù)護(hù)理計(jì)劃,實(shí)施延續(xù)護(hù)理計(jì)劃。采用便利抽樣法選取2016年2月～2017年1月在南京某三級(jí)甲等醫(yī)院的呼吸內(nèi)科128例住院患者作為研究對(duì)象,將呼吸內(nèi)科的一區(qū)和二區(qū)隨機(jī)分為干預(yù)組和對(duì)照組,每組各64例出院患者,隨訪時(shí)間為6個(gè)月,對(duì)照組出院患者接受呼吸內(nèi)科常規(guī)護(hù)理,而干預(yù)組出院患者則在接受呼吸內(nèi)科常規(guī)護(hù)理的基礎(chǔ)上,接受呼吸內(nèi)科出院患者醫(yī)院社區(qū)一體化的延續(xù)護(hù)理,并分別在呼吸內(nèi)科患者出院前、出院后1個(gè)月、出院后3個(gè)月和出院后6個(gè)月時(shí),采用自我管理能力測(cè)定量表(ESCA)、生存質(zhì)量調(diào)查問(wèn)卷(SF-36)、自行設(shè)計(jì)的衛(wèi)生服務(wù)利用調(diào)查問(wèn)卷和護(hù)理滿意度調(diào)查問(wèn)卷,對(duì)兩組患者進(jìn)行效果評(píng)價(jià),以評(píng)估對(duì)呼吸內(nèi)科出院患者實(shí)施醫(yī)院社區(qū)一體化延續(xù)護(hù)理模式的有效性和可行性。研究結(jié)果1.專家咨詢結(jié)果顯示,量表各條目CVI值為0.91～1.00,全部條目平均CVI=0.962,內(nèi)部一致性Cronbach'α系數(shù)為0.949,Guttman分半信度為0.919,同時(shí),重測(cè)信度為0.988,符合接受標(biāo)準(zhǔn)。2.呼吸內(nèi)科出院患者護(hù)理需求評(píng)估的結(jié)果顯示,80.7%的呼吸內(nèi)科出院患者希望在出院后繼續(xù)獲得延續(xù)護(hù)理;79.3%的患者選擇電話隨訪為服務(wù)形式;48.0%的患者希望每2周一次獲得延續(xù)護(hù)理,并希望醫(yī)院護(hù)士(占64.7%)和社區(qū)護(hù)士(52.0%)能為其提供護(hù)理服務(wù);超過(guò)半數(shù)的(占51.3%)患者愿意支付延續(xù)護(hù)理的費(fèi)用,在這些患者中,選擇按頻次收費(fèi)的患者占83.12%,收費(fèi)區(qū)間為10-150元。對(duì)呼吸內(nèi)科出院患者進(jìn)行護(hù)理問(wèn)題的評(píng)估,結(jié)果顯示,在患者出院時(shí),主要存在的護(hù)理問(wèn)題為呼吸(占100%)、健康照顧的督導(dǎo)(占80.7%)、認(rèn)知(占64.0%)、身體活動(dòng)(占52.7%)和藥物濫用(占51.3%)。3.兩組呼吸內(nèi)科出院患者自我管理能力的組間比較顯示,干預(yù)前,比較兩組患者自我管理能力的總分和各維度得分,結(jié)果顯示差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);干預(yù)后,比較兩組患者自我管理能力的總分,除出院1個(gè)月后,差異不具有統(tǒng)計(jì)學(xué)意義外(P0.05),出院3個(gè)月后和6個(gè)月后,差異均具有統(tǒng)計(jì)學(xué)意義(P0.05);干預(yù)后,比較兩組患者自我管理能力各維度得分,其中自我管理概念維度、自我責(zé)任感維度和自我管理技能維度,在出院1個(gè)月后、3個(gè)月后和6個(gè)月后差異均具有統(tǒng)計(jì)學(xué)意義(P0.05),而健康知識(shí)水平維度在出院1個(gè)月后、3個(gè)月后和6個(gè)月后的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。4.兩組呼吸內(nèi)科出院患者生存質(zhì)量的組間比較顯示,干預(yù)前,比較兩組患者生存質(zhì)量的總分和各維度得分,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);干預(yù)后,比較兩組患者生存質(zhì)量的總分,結(jié)果顯示出院1個(gè)月后、3個(gè)月后和6個(gè)月后,差異均具有統(tǒng)計(jì)學(xué)意義(P0.05);干預(yù)后,比較兩組患者生存質(zhì)量的各維度得分,結(jié)果顯示,在出院1個(gè)月后,總體健康(GH)、生理功能(PF)、生理職能(RP)、軀體疼痛(BP)、社會(huì)功能(SF)、情感職能(RE)、心理健康(MH)的得分的差異有統(tǒng)計(jì)學(xué)意義(P0.05),而在出院3個(gè)月后和6個(gè)月后,各維度間的差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。5.兩組呼吸內(nèi)科出院患者衛(wèi)生服務(wù)利用的組間比較顯示,在干預(yù)1個(gè)月后、3個(gè)月后和6個(gè)月后,兩組患者訪問(wèn)門診次數(shù)、再入院次數(shù)的差異均具有統(tǒng)計(jì)學(xué)意義(P0.05),而訪問(wèn)社區(qū)衛(wèi)生服務(wù)機(jī)構(gòu)、訪問(wèn)急診次數(shù)的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。6.兩組呼吸內(nèi)科出院患者的住院滿意度和社區(qū)衛(wèi)生機(jī)構(gòu)護(hù)理滿意度的組間比較顯示,干預(yù)前,兩組患者的住院護(hù)理滿意度評(píng)分和對(duì)社區(qū)衛(wèi)生機(jī)構(gòu)護(hù)理滿意的評(píng)分之間,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);干預(yù)1個(gè)月后、3個(gè)月后、6個(gè)月后,干預(yù)組患者對(duì)住院護(hù)理的滿意度和對(duì)社區(qū)護(hù)理的滿意度均顯著高于對(duì)照組(P0.05)。研究結(jié)論本研究所構(gòu)建的呼吸內(nèi)科出院患者醫(yī)院社區(qū)一體化延續(xù)護(hù)理模式能夠較好的適用于呼吸內(nèi)科出院患者。通過(guò)實(shí)施呼吸內(nèi)科出院患者醫(yī)院社區(qū)一體化延續(xù)護(hù)理服務(wù),能夠有效改善呼吸內(nèi)科出院患者的自我管理能力及生存質(zhì)量,使患者的自我管理能力及生存質(zhì)量達(dá)到較高水平,同時(shí),延續(xù)護(hù)理模式能夠有效降低患者訪問(wèn)訪問(wèn)門診的次數(shù)及再入院的次數(shù)等衛(wèi)生服務(wù)利用情況,使出院患者對(duì)住院時(shí)的護(hù)理滿意度和出院后社區(qū)護(hù)理的滿意度均得到有效地提高。
[Abstract]:Objective to construct the respiratory medicine for the situation of our country patients discharged from hospital community integration continued nursing mode. To evaluate the effect of the model, verify the implementation of the model can meet the discharge of respiratory medicine professional care needs of patients. Methods: This study adopts the Omaha question classification system as the theoretical framework, developed the "nursing of respiratory medicine the needs of the patients evaluation form"; at the same time, to investigate 150 cases of respiratory medicine nursing needs of patients and the existing hospital health problems. The results of preliminary investigation and literature at home and abroad based on the construction of respiratory medicine patients discharged from hospital community integration continue nursing service mode, mainly includes 3 parts: the three stage: the establishment of hospital patients with respiratory medicine information archives hospital, nursing assessment requirements and problems of patients, making continuing nursing plan, training and guidance of community nurses; II Between the three hospitals and community health service center: to establish a QQ communication platform, the hospital nurse will breathe electronic information archives of internal patients and extended care plan referrals to community health service centers, community nurses timely feedback progress; the community health service center: community nurses receive respiratory medicine hospital patients and the continuation of electronic information archives the nursing plan, nursing care plan. With the convenient sampling method from February 2016 to January 2017 in the Department of respiratory medicine in Nanjing from three hospitals in 128 patients as the research object, the respiratory medicine of a region and the two region were randomly divided into intervention group and control group, each group had 64 cases of discharged patients, follow-up time was 6 months, the control group patients received respiratory routine nursing care, while the intervention group patients in Department of Respiratory Medicine received routine nursing, respiratory medicine accepted Continue nursing patients in hospital community integration of the hospital, and were discharged in patients with respiratory medicine before and 1 months after discharge, 3 months after discharge and 6 months after discharge, the determination of the ability of self management scale (ESCA), quality of life questionnaire (SF-36), using questionnaire and nursing satisfaction questionnaire the self-designed health service, evaluation of two groups of patients, to evaluate the effectiveness of implementation of respiratory medicine hospital hospital community integration continued nursing mode and feasibility of patients. The results showed that 1. expert consultation results, scale of each entry CVI value from 0.91 to 1, the average CVI=0.962 of all entries, the internal consistency coefficient of Cronbach'0.949, Guttman split half reliability was 0.919, and the test-retest reliability was 0.988, with medical.2. standard nursing needs of patients with respiratory discharge evaluation results showed that 80.7% of the patients in respiratory department Want to continue to receive continuing nursing care after discharge; 79.3% of the patients selected for telephone follow-up service; 48% of the patients hope once every 2 weeks to get extended care, and hope that the hospital nurses (64.7%) and community nurses (52%) to provide care for their services; more than half (51.3%) were willing to pay for the continuation of the nursing cost in these patients, selected according to the frequency of charges accounted for 83.12% of patients, the toll area is 10-150 yuan. The assessment of respiratory medicine patients were nursing problems. The results show that when the patient was discharged, the main problems for respiratory care (100%), health care supervision (80.7%) cognitive, physical activity (64%), (52.7%) and drug abuse (51.3%) shows that the two group respiratory.3. discharge patients' ability of self-management among groups before intervention, compared two groups of patients self management ability of the total score and scores of each dimension, The results showed no statistically significant difference (P0.05); after the intervention, compared two groups of patients self management ability scores, except for 1 months after discharge, the difference was not statistically significance (P0.05), 3 months after discharge and 6 months later, the differences were statistically significant (P0.05); intervention, comparison two groups of patients self management ability scores, the concept of self management dimension, self responsibility dimensions and self management skills dimensions, in 1 months after discharge, the difference after 3 months and 6 months were statistically significant (P0.05), and the level of health knowledge dimension in 1 months after discharge, no statistically significant difference after 3 months and 6 months later (P0.05), two group comparison showed that the quality of life of patients with respiratory.4. discharge between groups before intervention, compared two groups of patients survival quality score and score of each dimension, the differences were not statistically significant (P0.05); after the intervention between the two groups 鎮(zhèn)ｈ，

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